Holbrooks Health Team
Good

Inspection Summary

Overall summary & rating

Good

Updated 21 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Holbrooks Health Team on 5 January 2016. Overall the practice is rated as good for providing safe, effective, caring, responsive and well led services.

Our key findings across all the areas we inspected were as follows:

There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Events were fully investigated by the practice and learning points identified and implemented.

The practice was a founder member of a local GP federation. This enabled learning and best practice to be shared more widely within GP practices within the local area.

Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned. Training needs were also identified and actioned as a result of patient feedback.

Information about services and how to complain was available and easy to understand. All complaints were fully investigated by the practice and learning points identified. These were also shared when appropriate within the local GP federation of which the practice was part, to enable learning to be more widely applied.

The practice had good facilities and was well equipped to treat patients and meet their needs. A range of health care related commercial services was also available on site, for example a pharmacy and hearing centre.

Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

The areas where the provider should make improvement are:

Ensure appropriate steps are taken to improve access to the service by telephone and for patients making appointments.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

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Inspection areas

Safe

Good

Updated 21 March 2016

The practice is rated as good for providing safe services. Staff understood their responsibilities to raise concerns, and identified and reported incidents and near misses. Learning points were identified and communicated widely amongst staff to support improvement. Information about safety was recorded, monitored, reviewed and addressed. Risks to patients were assessed and well managed. Appropriate safeguarding measures were in place to help protect children and vulnerable adults from the risk of abuse. There were enough staff to keep people safe.

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Effective

Good

Updated 21 March 2016

The practice is rated as good for providing effective services. Staff referred to guidance from the National Institute for Health and Care Excellence (NICE) and used it routinely. NICE is the organisation responsible for promoting clinical excellence and cost-effectiveness. They produced and issued clinical guidelines to ensure that every NHS patient gets fair access to quality treatment.

Patients’ needs were assessed and care was planned and delivered in line with current legislation. Staff had received training appropriate to their roles and any additional training needs were identified and planned to meet patient needs. Staff were appraised annually and had personal development plans in place. Staff worked with multidisciplinary teams to improve outcomes for patients.

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Caring

Good

Updated 21 March 2016

The practice is rated as good for providing caring services. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Information for patients about the services available was easy to understand and accessible. We saw that staff treated patients with kindness and respect, and maintained confidentiality.

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Responsive

Good

Updated 21 March 2016

The practice is rated as good for providing responsive services. It identified and reviewed the needs of its local population and engaged with the NHS England Area Team and the Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. Patients said they were able to make an appointment with a GP and that there was continuity of care, with urgent appointments available the same day. Extended hours opening was available every weekday from 7am.

The practice building was purpose built and well equipped to treat patients and meet their needs.

A range of health care related community services was also available within the practice buildings, for example a pharmacy and hearing centre.

Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

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Well-led

Good

Updated 21 March 2016

The practice is rated as good for being well-led. It had a clear vision and strategy. Staff were clear about the vision and their responsibilities in relation to this. There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings. Appropriate systems were in place to monitor and improve quality and identify risk. The practice proactively sought feedback from staff and patients, which it acted on. The practice had an active patient participation group and responded to feedback from patients about ways that improvements could be made to the services offered. Staff had received inductions, regular performance reviews and attended staff meetings and events.

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Checks on specific services

People with long term conditions

Good

Updated 21 March 2016

The practice is rated as good for the care of people with long-term conditions. The practice used a chronic disease management system to monitor patients with chronic diseases. Patients at risk of hospital admission were closely monitored. Longer appointments and home visits were available when needed. Patients were reviewed at least annually, sometimes more frequently depending on the condition they had and its severity. All patients diagnosed with a long term condition had a named GP and a structured annual review to check that their health and medicine needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice also offered dietary, weight management and smoking cessation advice.

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Families, children and young people

Good

Updated 21 March 2016

The practice is rated as good for the care of families, children and young people. There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk of abuse. For example, children and young people who had a high number of accident and emergency (A&E) attendances.

The practice ran baby clinics and offered appointments with the midwife who was based at the practice. The practice had a policy providing same day appointments for children and appointments were also available outside of school hours. The premises were suitable and accessible for children, with changing facilities for babies. We saw good examples of joint working with midwives, health visitors, school nurses and district nurses. The practice notified Child Health Services when babies and children did not attend for their vaccinations. Walk in sessions were held for children’s vaccinations on Saturday mornings and periodic child health promotion days were organised.

The practice also offered a number of online services including booking appointments and requesting repeat medicines.

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Older people

Good

Updated 21 March 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population. It was responsive to the needs of older people, and offered home visits for those unable to reach the practice. GPs also made proactive telephone calls and weekly visits to five care homes where patients lived. Health checks were carried out for all patients over the age of 75 years. At the time of our inspection, the practice had started to plan its 2015-2016 flu vaccination programme.

The practice employed a patient care co-ordinator who handled telephone calls from patients who are most at risk, care homes, requested patient transport and liaised with the district nursing team, amongst other duties.

The practice offered a variety of community events to raise health awareness within this patient group. This included a ‘Winter Warmers’ event in conjunction with Coventry City Council to identify health and social needs with the over 70’s.

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Working age people (including those recently retired and students)

Good

Updated 21 March 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of the working age population, those recently retired and students had been identified. Telephone consultations were available for patients who were unable to reach the practice during the day. Extended hours opening was offered with appointments available from 7am during the week. Telephone consultations were also available with GPs and practice nurses for patients unable to reach the practice during the day.

The practice was proactive in offering online services as well as a full range of health promotion and screening services that reflected the needs for this age group. The practice nurse had oversight for the management of a number of clinical areas, including immunisations. Adult health awareness days were held by the practice twice every year on Saturday mornings. These provided lifestyle advice along with weight and blood pressure checks.

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People experiencing poor mental health (including people with dementia)

Good

Updated 21 March 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice regularly worked with multi-disciplinary teams to plan care and treatment with patients who experienced poor mental health, including those with dementia. It carried out advanced care planning and annual health checks for patients with dementia and poor mental health. The GP and practice nurse understood the importance of considering patients’ ability to consent to care and treatment and dealt with this in accordance with the requirements of the Mental Capacity Act 2005.

The practice had advised patients experiencing poor mental health how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E). Staff had received training on how to care for people with mental health needs and dementia.

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People whose circumstances may make them vulnerable

Good

Updated 21 March 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances including those patients with a learning disability. For example, the practice had carried out annual health checks and offered longer appointments for patients with a learning disability. Homeless patients were also registered at the practice.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had advised vulnerable patients on how to access various support groups and voluntary organisations. Alerts were placed on these patients’ records so that staff were aware they might need to be prioritised for appointments and offered additional attention such as longer appointments. The practice identified and closely monitored vulnerable patients who frequently attended accident and emergency (A&E).

Staff had received training and knew how to recognise signs of abuse in adults whose circumstances made them vulnerable and children who were considered to be at risk of harm. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

The practice had a strong link with the local Coventry Recovery Partnership which although now an independent organisation, had been initiated by the practice in 1984 and provided advice and assistance for patients with alcohol and drug related problems.

Inspection ratings

We rate most services according to how safe, effective, caring, responsive and well-led they are, using four levels:

Outstanding – the service is performing exceptionally well.

Good – the service is performing well and meeting our expectations.

Requires improvement – the service isn't performing as well as it should and we have told the service how it must improve.

Inadequate – the service is performing badly and we've taken enforcement action against the provider of the service.

No rating/under appeal/rating suspended – there are some services which we can’t rate, while some might be under appeal from the provider. Suspended ratings are being reviewed by us and will be published soon.

Ticks and crosses

We don't rate every type of service. For services we haven't rated we use ticks and crosses to show whether we've asked them to take further action or taken enforcement action against them.

There's no need for the service to take further action. If this service has not had a CQC inspection since it registered with us, our judgement may be based on our assessment of declarations and evidence supplied by the service.

The service must make improvements.

At least one standard in this area was not being met when we inspected the service and we have taken enforcement action.